medwireNews: How people with bipolar disorder respond to their symptoms significantly impacts on their subsequent mood, researchers have found.

The finding is in line with Nolen-Hoeksema's response style theory and provides support for the use of psychotherapies that modify coping strategies, says the team led by Hana Pavlickova (Bangor University, UK).

"Our findings highlight the importance of therapeutic strategies to ameliorate rumination in bipolar patients, and also the potential value of psychoeducational methods of reducing risk taking in response to incipient manic symptoms," the researchers report.

They used the Hamilton Rating scale for Depression and the Bech-Refaelson Mania Scale to assess baseline symptoms in 48 individuals with bipolar disorder. The patients then completed experience sampling diaries documenting their mood, self-esteem, and response styles to depression up to 60 times over a period of 6 days. All the variables were rated on 7-point Likert scales.

As reported in PLoS One, symptoms of depression were significantly associated with low self-esteem and high negative affect, as well as with pronounced fluctuations in these variables.

Manic symptoms, rather than showing opposing associations to that of depression, showed similar associations with these variables, although the effect was smaller.

In accordance with the response style theory, Pavlickova et al found that symptoms of depression were significantly associated with increased rumination, which in turn dampened mood at a subsequent time.

"Furthermore, rumination led to decrease in positive affect only in individuals with few symptoms of mania, whilst no effect was found in those with manic symptoms," the researchers write.

"These findings are in line with Nolen-Hoeksema's notion that rumination as such does not cause depression, but rather moderates already depressive mood."

By contrast, high positive affect was marginally associated with risk-taking, participation in which increased positive mood at a subsequent time.

The researchers note that there was no association between risk-taking and negative affect, which they say "implies that this response style might not necessarily act as a defense against low mood as proposed previously."

Adaptive coping, involving problem-solving and distraction strategies, was associated with subsequent improvements in mood and self-esteem, making it "a top-down strategy that can be deliberately employed to improve one's affective state," say Pavlickova and team.

They add that this implies that "individuals with severe illness retain some ability to effectively regulate their mood."